Commentary: Integrative, multi-level explanatory models are needed to understand recent trends in sex, gender, and internalizing conditions, reflections on Keyes and Platt (2023).

Keyes' and Platt's (The Journal of Child Psychology and Psychiatry, 2023) review provides much-needed systematic evidence about why internalizing symptoms have increased and it clarifies the role of novel risk factors. The findings highlight that multiple factors at multiple levels are responsible for this phenomenon, many with small effects, within a complex interplay that is rarely well captured. As new insights emerge across disciplines, an important step is to renew efforts to integrate them to understand how internalizing symptoms develop for different people.

Associations of actigraphy-assessed sleep variables with adiposity and serum cardiometabolic outcomes in emerging adults.

This study assessed associations of actigraphy-assessed sleep with adiposity and serum cardiometabolic outcomes in emerging adults, and whether sex and race modified these associations. Data on 147 emerging adults (age = 19.4 ± 1.3 years; body mass index = 26.4 ± 7.0 kg m-2 ; 59% female; 65% White) from RIGHT Track Health were used. Actigraphy-based sleep measures included sleep duration, sleep efficiency, sleep timing midpoint, day-to-day sleep duration and sleep timing midpoint variability. Combined sleep duration and sleep timing behaviours were also derived (early-bed/late-rise, early-bed/early-rise, late-bed/late-rise, late-bed/early-rise). Outcomes included body mass index and BodPod-assessed fat mass index, fasting serum leptin, C-reactive protein, and homeostatic model assessment-insulin resistance. Sleep duration was 5.4 h per night. We noted an inverse association between sleep duration and homeostatic model assessment-insulin resistance. The early-bed/early-rise group had greater body mass index, C-reactive protein and homeostatic model assessment-insulin resistance compared with the early-bed/late-rise group (referent). Sex modified associations of sleep efficiency with C-reactive protein; stratified results revealed positive association between sleep efficiency and C-reactive protein in males, but not females. Race modified associations of sleep duration with body mass index and leptin, and of sleep duration variability with C-reactive protein. Stratified analyses revealed inverse associations between sleep duration with body mass index and leptin in Black, multiracial/other race individuals only. Positive association between sleep duration variability and C-reactive protein was noted in White individuals only. Shorter sleep duration, particularly when combined with earlier sleep timing, is associated with greater adiposity and serum cardiometabolic outcomes. Additional studies are needed to assess individual- and contextual-level factors that may contribute to sex and race differences in sleep health and cardiometabolic risk in emerging adults.

Higher paracetamol levels are associated with elevated glucocorticoid concentrations in hair: findings from a large cohort of young adults.

Paracetamol is one of the most commonly used over-the-counter medications. Experimental studies suggest a possible stress-suppressing effect of paracetamol in humans facing experimental stress-inducing paradigms. However, no study has investigated whether paracetamol and steroid hormones covary over longer time frames and under real-life conditions. This study addresses this gap by investigating associations between steroid hormones (cortisol, cortisone, and testosterone) and paracetamol concentrations measured in human hair, indexing a timeframe of approximately three months. The data came from a large community sample of young adults (N = 1002). Hair data were assayed using liquid chromatography-tandem mass spectrometry. Multiple regression models tested associations between paracetamol and  steroid hormones, while adjusting for a wide range of potential confounders, such as sex, stressful live events, psychoactive substance use, hair colour, and body mass index. Almost one in four young adults from the community had detectable paracetamol in their hair (23%). Higher paracetamol hair concentrations were robustly associated with more cortisol (ß = 0.13, ηp = 0.016, p < 0.001) and cortisone (ß = 0.16, ηp = 0.025, p < 0.001) in hair. Paracetamol and testosterone hair concentrations were not associated. Paracetamol use intensity positively correlated with corticosteroid functioning across several months. However, a potential corticosteroid-inducing effect of chronic paracetamol use has yet to be tested in future experimental designs.

Disentangling the effects of self-control and the use of tobacco and cannabis on violence perpetration from childhood to early adulthood.

Associations among self-control, substance use (e.g., tobacco and cannabis use), and violence perpetration have been documented during the adolescent years, but the direction of these associations is not well understood. Using five assessments (covering 9 years) from a prospective-longitudinal study, we examined self-control as a precursor and subsequent mechanism of associations between adolescent substance use and physical violence perpetration. Data came from a large, ethnically diverse sample (n = 1,056). Youth reported their self-control at ages 11, 13, 15, 17, and 20; and their tobacco and cannabis use, and physical violence perpetration at ages 13, 15, 17, and 20. Cross-lagged panel analyses examined associations between these constructs over time. More self-control in late childhood and early adolescence was associated with less future tobacco and cannabis use and physical violence perpetration. Tobacco use was partially associated with more physical violence over time; these associations were not mediated by self-control. Tobacco use in early adolescence was associated with future cannabis use; during late adolescence, tobacco and cannabis use were reciprocally associated over time. Cannabis use was not associated with future physical violence perpetration. Early adolescent self-control plays an important role in later substance use and violence perpetration, and tobacco use has unique links with both later cannabis use and violence perpetration. Supporting the capacities for self-control in late childhood and early adolescence and preventing the initiation and use of entry-level substances could play an important role in preventing both substance use and violence perpetration and their many costs to society.

Continuity of mental disorders in children with chronic physical illness.

Data on the chronicity of mental disorder in children with chronic physical illness (CPI) are limited. We examined the prevalence and predictors of homotypic and heterotypic continuity of mental disorder in children with CPI. A sample of 263 children aged 2-16 years with physician-diagnosed CPI were recruited from outpatient clinics (e.g., dermatology, respiratory) at a Canadian pediatric academic hospital and followed for 24 months. Parent and child-reported mental disorders (mood, anxiety, behavioral, attention-deficit hyperactivity disorder [ADHD]) were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents at baseline, 6, 12, and 24 months. Marginal regression models were computed to identify clinical, parent, and demographic factors associated with mental comorbidity over time. Mental disorder was observed in 24-27% of children with CPI based on child reports and 35-39% based on parent reports. Parent-reported models revealed significant homotypic continuity for all mental disorders (ORs = 4.2-9.5), and heterotypic continuity between mood and anxiety disorders (OR = 2.2), ADHD and behavioral disorders (OR = 5.1), and behavioral and each mental disorder (ORs = 6.7-8.4). Child-reported models revealed significant homotypic continuity for mood (OR = 8.8) and anxiety disorder (OR = 6.0), and heterotypic continuity between anxiety and mood disorders (OR = 12.4). Child disability (ORs = 1.3-1.5) and parent psychopathology (ORs = 1.2-1.8) were the most consistent predictors of both child- and parent-reported mental disorder over time. Mental comorbidity was prevalent and persistent in children with CPI with homotypic and heterotypic continuity common across informants. Child disability and parent psychopathology may be priority targets within integrated family-centered models of care to prevent mental comorbidity in children with CPI.

Taking John Schulenberg's "long view" on successful transitions to adulthood: Associations with adult substance use.

Can positive transitions into young adulthood at age 25 prevent problematic substance use at age 31, even in the context of childhood adverse family environments, conduct problems, and adolescent substance use? We lean on John Schulenberg's developmental framework to examine this question, focusing on the potential young adult milestones of high school and college graduation, employment, residential independence, romantic partnership, and parenthood. Data came from a prospective-longitudinal multi-method study with N = 1199 participants who were first assessed at age 5 years old and followed to age 31. An accumulation of positive transitions in young adulthood (age 25) was associated with lower likelihood of age 31 problematic cannabis use. The protective effect for problematic cannabis use remained even when adjusting for childhood adverse family environments and was primarily driven by successful college graduation and/or home ownership. The accumulation of positive transitions protected individuals at modest to somewhat elevated risk due to childhood adverse family environments from experiencing age 31 cannabis use problems. However, for other individuals with very high numbers of conduct problems, or with high levels of adolescent substance use, the protective effects of accumulated positive transitions to young adulthood were less strong or nonexistent. Moreover, individuals who completed college or obtained full-time employment by 25 were more likely to report problematic age 31 alcohol use. These findings highlight the central tenets of John Schulenberg's developmental framework, including the examination of ontogenetic continuity and discontinuity, the interplay of developmentally distal and proximal effects, and the identification of developmental protective factors that may sway people toward or away from substance use.

Assessing the Effect of First-time Police Contact on Internalizing Problems Among Youth in Zurich, Switzerland: A Quasi-experimental Analysis.

Growing evidence suggests that experiences with police are associated with a range of negative mental health problems among youth. This study examined the impact of negative police contact on changes in adolescent internalizing problems, measured by anxiety and depression. Six waves of data from a longitudinal study in Zurich, Switzerland were used in order to assess the direct relations between first reported police contact in the years prior to the survey moment and internalizing problems at the time of the survey and follow-up waves. The sample consists of a cohort of youth (max n = 1353, 49.4% females) spanning ages 11 to 24 (mean age and SD at each wave = 11.32 (0.37), 13.67 (0.36), 15.44 (0.36), 17.45 (0.37), 20.58 (0.38), 24.46 (0.38)). Specifically, difference-in-differences techniques for multiple time periods were employed to assess the average treatment effects for the treated population (first contact with police) compared to those who were never treated (never had contact). Across all models, police contact did not lead to an increase in internalizing problems. These results diverge from previous studies mostly conducted in the United States, and possible explanations including differences in historical contexts of policing, juvenile justice, health care, and dosage of intrusive contacts are discussed.

Physiologic and Behavioral Correlates of Energy Intake in Emerging Adulthood: Cross-Sectional Analysis of the RIGHT Track Health Study.

BACKGROUND: Consistent findings have reported that FFM is associated with EI. However, conjoint assessments of physiologic (body composition, fasting serum leptin) and behavioral [eating behaviors and physical activity (PA)] correlates of EI during emerging adulthood have not been examined. OBJECTIVES: We assessed associations between physiologic and behavioral correlates of EI within the context of one another in emerging adults (18-28 years old). We also assessed these associations in a subsample after the removal of probable EI underreporters. METHODS: Cross-sectional data from 244 emerging adults (age = 19.6 ± 1.4 y; BMI = 26.4 ± 6.6 kg/m2; 56.6% female) from the RIGHT Track Health study were used. Measures included body composition (BOD POD), eating behaviors (Three-Factor Eating Questionnaire), objective and subjective PA (accelerometer-derived total activity counts and Godin-Shephard Leisure-Time Exercise Questionnaire), fasting serum leptin, and EI (three 24-hour dietary recalls). Correlates independently associated with EI were entered into a backward stepwise linear regression model. Correlates that met the criteria of P < 0.05 were retained. Analyses were repeated in a subsample after removing probable EI underreporters (n = 48). Effect modification by sex (male and female) and BMI (BMI < 25 kg/m2, BMI ≥ 25 kg/m2) categories was also assessed. RESULTS: In the full sample, FFM (ß: 18.4; 95% CI: 9.9, 26.8), leptin (ß: -84.8; 95% CI: -154.3, -15.4), dietary restraint (ß: -35.2; 95% CI: -59.1, -11.3), and subjective PA (ß: 2.5; 95% CI: 0.04, 4.9) were significantly associated with EI. After the removal of probable underreporters, only FFM remained significantly associated with EI (ß: 43.9; 95% CI: 27.2, 60.6). No evidence of effect modification by sex or BMI categories was noted. CONCLUSIONS: Although physiologic and behavioral correlates were associated with EI in the full sample, only FFM remained a robust correlate of EI in a subsample of emerging adults after removing probable EI underreporters.

Self-, other-, and dual-harm during adolescence: a prospective-longitudinal study of childhood risk factors and early adult correlates.

BACKGROUND: Little is known about the childhood antecedents and adult correlates of adolescent dual-harm (i.e. co-occurring self- and other-harm). We examine the longitudinal associations between (a) social and psychological risk factors in childhood and adolescent dual-harm and (b) adolescent dual-harm and social and mental health impairments in early adulthood. METHODS: Participants (N = 1482) are from a prospective longitudinal community-representative study. Dual-, self-, and other-harm were self-reported at ages 13, 15, and 17. Social and psychological risk factors in childhood were assessed between 7 and 11; early adult correlates at age 20. Groups with dual-harm, self-harm only, other-harm only, and no harm were compared. RESULTS: Between 13 and 17, 7.2% of adolescents reported dual-harm (self-harm only: 16.2%; other-harm only: 13.3%). Some childhood risk factors (e.g. sensation-seeking, parental divorce, victimization by peers) characterized all harm groups; others were common to the dual- and self-harm (anxiety/depressive symptoms, relational aggression) or dual- and other-harm groups only (low self-control, substance use, delinquency). Adolescents with dual-harm had reported more physical aggression and harsh parenting, and lower school bonding in childhood than any other group. In early adulthood, they reported more anxiety/depressive symptoms, psychopathy symptoms, homicidal ideations, delinquency, and victimization experiences than any other group. CONCLUSIONS: Adolescent dual-harm follows psychological problems and social disconnection in childhood and signals risk of psychopathology and isolation in early adulthood. To curb the burden from dual-harm, interventions must target adolescents, families, peer networks, and school environments. Differentiating youth with dual-harm from those with single-harm is important for developing personalized treatments.

Childhood loneliness as a specific risk factor for adult psychiatric disorders.

BACKGROUND: Loneliness is a major risk factor for both psychological disturbance and poor health outcomes in adults. This study aimed to assess whether childhood loneliness is associated with a long-term disruption in mental health that extends into adulthood. METHODS: This study is based on the longitudinal, community-representative Great Smoky Mountains Study of 1420 participants. Participants were assessed with the structured Child and Adolescent Psychiatric Assessment interview up to eight times in childhood (ages 9-16; 6674 observations; 1993-2000) for childhood loneliness, associated psychiatric comorbidities and childhood adversities. Participants were followed up four times in adulthood (ages 19, 21, 25, and 30; 4556 observations of 1334 participants; 1999-2015) with the structured Young Adult Psychiatric Assessment Interview for psychiatric anxiety, depression, and substance use outcomes. RESULTS: Both self and parent-reported childhood loneliness were associated with adult self-reported anxiety and depressive outcomes. The associations remained significant when childhood adversities and psychiatric comorbidities were accounted for. There was no evidence for an association of childhood loneliness with adult substance use disorders. More associations were found between childhood loneliness and adult psychiatric symptoms than with adult diagnostic status. CONCLUSION: Childhood loneliness is associated with anxiety and depressive disorders in young adults, suggesting that loneliness - even in childhood - might have long-term costs in terms of mental health. This study underscores the importance of intervening early to prevent loneliness and its sequelae over time.

Adult criminal outcomes of juvenile justice involvement.

BACKGROUND: The juvenile justice system in the USA adjudicates over seven hundred thousand youth in the USA annually with significant behavioral offenses. This study aimed to test the effect of juvenile justice involvement on adult criminal outcomes. METHODS: Analyses were based on a prospective, population-based study of 1420 children followed up to eight times during childhood (ages 9-16; 6674 observations) about juvenile justice involvement in the late 1990 and early 2000s. Participants were followed up years later to assess adult criminality, using self-report and official records. A propensity score (i.e. inverse probability) weighting approach was used that approximated an experimental design by balancing potentially confounding characteristics between children with v. without juvenile justice involvement. RESULTS: Between-groups differences on variables that elicit a juvenile justice referral (e.g. violence, property offenses, status offenses, and substance misuse) were attenuated after applying propensity-based inverse probability weights. Participants with a history of juvenile justice involvement were more likely to have later official and violent felony charges, and to self-report police contact and spending time in jail (ORs from 2.5 to 3.3). Residential juvenile justice involvement was associated with the highest risk of both, later official criminal records and self-reported criminality (ORs from 5.1 to 14.5). Sensitivity analyses suggest that our findings are likely robust to potential unobserved confounders. CONCLUSIONS: Juvenile justice involvement was associated with increased risk of adult criminality, with residential services associated with highest risk. Juvenile justice involvement may catalyze rather than deter from adult offending.

Longitudinal associations between specific types of emotional reactivity and psychological, physical health, and school adjustment.

Using a multimethod, multiinformant longitudinal design, we examined associations between specific forms of positive and negative emotional reactivity at age 5, children's effortful control (EC), emotion regulation, and social skills at age 7, and adolescent functioning across psychological, academic, and physical health domains at ages 15/16 (N = 383). We examined how distinct components of childhood emotional reactivity directly and indirectly predict domain-specific forms of adolescent adjustment, thereby identifying developmental pathways between specific types of emotional reactivity and adjustment above and beyond the propensity to express other forms of emotional reactivity. Age 5 high-intensity positivity was associated with lower age 7 EC and more adolescent risk-taking; age 5 low-intensity positivity was associated with better age 7 EC and adolescent cardiovascular health, providing evidence for the heterogeneity of positive emotional reactivity. Indirect effects indicated that children's age 7 social skills partially explain several associations between age 5 fear and anger reactivity and adolescent adjustment. Moreover, age 5 anger reactivity, low-, and high-intensity positivity were associated with adolescent adjustment via age 7 EC. The findings from this interdisciplinary, long-term longitudinal study have significant implications for prevention and intervention work aiming to understand the role of emotional reactivity in the etiology of adjustment and psychopathology.

Developmental Trajectories of Self-, Other-, and Dual-Harm across Adolescence: The Role of Relationships with Peers and Teachers.

INTRODUCTION: We investigated the longitudinal course of self-, other-, and dual-harm in adolescents, focusing on the infliction of physical injury on oneself, another person, or both parties, respectively. We examined the within-person transitions between these types of harm and whether relationships with peers and teachers predict individual harm trajectories. METHODS: We used community-representative longitudinal data (N = 1,482; 52% male; 50% both parents born abroad). The participants self-reported self- and other-harm at 13, 15, 17, and 20 years. We assigned them to groups with self-, other-, dual- or no harm at specific assessments. Bullying victimization and relationship quality with classmates and teachers were assessed at 13 and 17. We estimated transition probabilities between the harm groups using latent Markov chain models. RESULTS: At age 13, 3% of the sample engaged in dual-harm, 10% in self-harm only, and 7% in other-harm only. These percentages decreased in late adolescence. Initial dual-harm was often followed by sex-specific single-harm: most of the female participants transitioned to self-harm, and male participants to other-harm. Those in the initial dual-harm group were less likely to stop harming than those in the initial single-harm groups (p < 0.05). Adverse relationship experiences generally predicted harm. A positive teacher-student bond was associated with the cessation of single-harm. CONCLUSION: Single- and dual-harm in the form of physical injury typically emerge by mid-adolescence. After this point, adolescents commonly maintain harm, especially those who have presented with dual-harm. Helping adolescents cope with adverse relationship experiences and creating opportunities for positive relationship experiences could address these harmful behaviors.

Emotional distress in young adults during the COVID-19 pandemic: evidence of risk and resilience from a longitudinal cohort study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic and associated lockdown could be considered a 'perfect storm' for increases in emotional distress. Such increases can only be identified by studies that use data collected before and during the pandemic. Longitudinal data are also needed to examine (1) the roles of previous distress and stressors in emotional distress during the pandemic and (2) how COVID-19-related stressors and coping strategies are associated with emotional distress when pre-pandemic distress is accounted for. METHODS: Data came from a cohort study (N = 768). Emotional distress (perceived stress, internalizing symptoms, and anger), COVID-19-related stressors, and coping strategies were measured during the pandemic/lockdown when participants were aged 22. Previous distress and stressors were measured before COVID-19 (at age 20). RESULTS: On average, participants showed increased levels of perceived stress and anger (but not internalizing symptoms) during the pandemic compared to before. Pre-COVID-19 emotional distress was the strongest predictor of during-pandemic emotional distress, followed by during-pandemic economic and psychosocial stressors (e.g. lifestyle and economic disruptions) and hopelessness, and pre-pandemic social stressors (e.g. bullying victimization and stressful life events). Most health risks to self or loved ones due to COVID-19 were not uniquely associated with emotional distress in final models. Coping strategies associated with reduced distress included keeping a daily routine, physical activity, and positive reappraisal/reframing. CONCLUSIONS: In our community sample, pre-pandemic distress, secondary consequences of the pandemic (e.g. lifestyle and economic disruptions), and pre-pandemic social stressors were more consistently associated with young adults' emotional distress than COVID-19-related health risk exposures.

Early adversities accelerate epigenetic aging into adulthood: a 10-year, within-subject analysis.

BACKGROUND: Longitudinal studies are needed to clarify whether early adversities are associated with advanced methylation age or if they actually accelerate methylation aging. This study test whether different dimensions of childhood adversity accelerate biological aging from childhood to adulthood, and, if so, via which mechanisms. METHODS: 381 participants provided one blood sample in childhood (average age 15.0; SD = 2.3) and another in young adulthood (average age 23.1; SD = 2.8). Participants and their parents provided a median of 6 childhood assessments (total = 1,950 childhood observations), reporting exposures to different types of adversity dimensions (i.e. threat, material deprivation, loss, unpredictability). The blood samples were assayed to estimate DNA methylation age in both childhood and adulthood and also change in methylation age across this period. RESULTS: Cross-sectional associations between the childhood adversity dimensions and childhood measures of methylation age were non-significant. In contrast, multiple adversity dimensions were associated with accelerated within-person change in methylation age from adolescence to young adulthood. These associations attenuated in model testing all dimensions at the same time. Accelerated aging increased with increasing number of childhood adversities: Individuals with highest number of adversities experienced 2+ additional years of methylation aging compared to those with no exposure to childhood adversities. The association between total childhood adversity exposure and accelerated aging was partially explained by childhood depressive symptoms, but not anxiety or behavioral symptoms. CONCLUSIONS: Early adversities accelerate epigenetic aging long after they occur, in proportion to the total number of such experiences, and in a manner consistent with a shared effect that crosses multiple early dimensions of risk.

Pathways from maternal depressive symptoms to children's academic performance in adolescence: A 13-year prospective-longitudinal study.

The pathways through which exposure to maternal depressive symptoms in early childhood are linked to academic performance during adolescence are poorly understood. This study tested pathways from maternal depressive symptoms (age 2-5) to adolescent academic performance (age 15) through cumulative parenting risk (age 7) and subsequent child functioning (age 10), using multi-informant data from a prospective longitudinal community study spanning 13 years (N = 389, 47% male, 68% White). Structural equation models testing indirect effects revealed small associations between maternal depressive symptoms and increased cumulative parenting risk and poorer child functioning, and, via these pathways, with poorer academic performance. Thus, childhood exposure to maternal depressive symptoms may be associated with pathways of risk that could limit children's educational opportunities.

Prevalence and Correlates of Physical-mental Multimorbidity in Outpatient Children From a Pediatric Hospital in Canada.

OBJECTIVE: The aim of this study was to estimate the six-month prevalence of mental illness in children with chronic physical illness (multimorbidity), examine agreement between parent and child reports of multimorbidity, and identify factors associated with child multimorbidity. METHOD: The sample included 263 children aged 2-16 years with a physician-diagnosed chronic physical illness recruited from the outpatient clinics at a pediatric hospital. Children were categorized by physical illness according to the International Statistical Classification of Diseases and Related Health Problems (ICD)-10. Parent and child-reported six-month mental illness was based on the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). RESULTS: Overall, 101 (38%) of children had a parent-reported mental illness; 29 (25%) children self-reported mental illness. There were no differences in prevalence across ICD-10 classifications. Parent-child agreement on the MINI-KID was low (κ = 0.18), ranging from κ = 0.24 for specific phobia to κ = 0.03 for attention-deficit hyperactivity. From logistic regression modeling (odds ratio [OR] and 95% confidence interval), factors associated with multimorbidity were: child age (OR = 1.16 [1.04, 1.31]), male (OR = 3.76 [1.54, 9.22]), ≥$90,000 household income (OR = 2.57 [1.08, 6.22]), parental symptoms of depression (OR = 1.09 [1.03, 1.14]), and child disability (OR = 1.21 [1.13, 1.30]). Similar results were obtained when modeling number of mental illnesses. CONCLUSIONS: Findings suggest that six-month multimorbidity is common and similar across different physical illnesses. Level of disability is a robust, potentially modifiable correlate of multimorbidity that can be assessed routinely by health professionals in the pediatric setting to initiate early mental health intervention to reduce the incidence of multimorbidity in children.

High Prevalence and Early Onsets: Legal and Illegal Substance Use in an Urban Cohort of Young Adults in Switzerland.

INTRODUCTION: Debates about the legalization of illegal substances (e.g., cannabis) continue around the globe. A key consideration in these debates is the adequate protection of young people, which could be informed by current prevalence and age-of-onset patterns. For Switzerland, such information is limited, which is particularly true for women, despite advanced political efforts to legalize cannabis. The objective of the current study was to investigate substance use prevalence rates and ages of onset in a community-representative sample of female and male young adults in Switzerland. METHODS: Data came from the Zurich Project on the Social Development from Childhood to Adulthood (z-proso). In 2018, participants (N = 1,180, 50.8% females) were ∼20 years old. Lifetime and past-year use of alcohol, tobacco, cannabinoids, stimulants, hallucinogens, opioids, and benzodiazepines were assessed with an extensive substance use questionnaire. Additionally, ages of onsets of the respective substances were estimated by averaging participants' self-reported ages of onsets from ages 13 to 20 (max. 4 assessments). RESULTS: 57% of 20-year-olds had used cannabinoids, 16% stimulants, 15% opioids (mostly codeine), and 8% hallucinogens in the past year. Males had higher prevalence than females for most drugs; nevertheless, females' prevalence rates were notably high. Legal substance use was typically initiated 1.3-2.7 years before legal selling age. Thus, almost half of the sample had consumed alcohol and tobacco by age 14. More than 40% of the total sample had smoked cannabis by age 16. Males initiated use of legal substances and cannabis earlier than females. DISCUSSION: Our recent community-representative data suggested unexpectedly high levels and early onsets of substance use compared to a previous Swiss surveys and also the European average. Drug policy debates should consider urban substance use patterns when considering legalization efforts.

Parental perception of mental health needs in young children.

BACKGROUND: There is evidence of unmet psychiatric needs in children under 6. These young children are dependent on their parents to identify their mental health needs. This study tested child and parent associations with parent perception of young child mental health need. METHOD: Parents of 917 children (aged 2-6 years) completed a diagnostic interview about their child assessing depression, anxiety, ODD/CD, ADHD, and impairment. Parents were surveyed about their own depression, anxiety, and asked about their psychiatric impairment. Parents were also asked whether they perceived their child as having a mental health need. RESULTS: Only 38.8% of children who met criteria for a diagnosis were perceived by their parents as having a need, similar to previously studied rates in school-aged children. Perception of need was associated with higher levels of symptoms and impairment. Thresholds for at least half of parents perceiving their child as having a need were relatively high: 19 or more symptoms, or 4 or more impairments. There was evidence of specificity: children with depressive disorders were more likely to be perceived as in need compared with other disorders. In terms of parent factors, more parental depressive symptoms were associated with higher perception of child need when the child had a diagnosis. Parental psychological impairment was associated with higher perception of need when the child had no diagnosis. CONCLUSIONS: Most preschool children that meet criteria for a psychiatric disorder are not perceived as needing help by their parents, which is dependent on both child and parent factors.

Health-related quality of life in children with and without physical-mental multimorbidity.

PURPOSE: This study examined health-related quality of life (HRQL) in children across different physical illnesses; estimated parent-child agreement on HRQL reports; compared HRQL between children with and without physical-mental multimorbidity; and tested if multimorbidity was associated with HRQL. METHODS: Children aged 6-16 years (mean = 11.1; n = 198) with one physical illness and their parents were recruited from a pediatric hospital. Physical illnesses were classified according to the International Statistical Classification of Diseases and Related Health Problems (ICD)-10, mental illnesses were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents, and HRQL was measured using the KIDSCREEN-27. Children who screened positive for ≥ 1 mental illness were classified as having physical-mental multimorbidity. χ2/t tests compared sample characteristics of children with vs. without multimorbidity; Kruskal-Wallis tests compared KIDSCREEN-27 scores across ICD-10 categories; interclass correlation coefficients estimated parent-child agreement; and multiple regression examined effects of the number of mental illnesses on HRQL. RESULTS: HRQL was similar across ICD-10 categories. Parent-child agreement was fair to good for all HRQL domains, regardless of multimorbidity status. Parent-reported HRQL was significantly lower for children with multimorbidity compared to norms across all domains, whereas child-reported HRQL was significantly lower for physical well-being, psychological well-being, and school environment. Number of mental illnesses was negatively associated with psychological well-being and school environment in a dose-response manner. CONCLUSION: Children with physical-mental multimorbidity are vulnerable to experiencing lower HRQL, particularly for psychological well-being and school environment. Longitudinal studies documenting trajectories of HRQL and school-based interventions that target these domains of HRQL for children with multimorbidity are warranted.